What Is Comorbid Depression?

Medically reviewed by Melissa Guarnaccia, LCSW
Updated October 14, 2024by BetterHelp Editorial Team
Please be advised, the below article might mention trauma-related topics that include suicide, substance use, or abuse which could be triggering to the reader.
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There are many terms used when discussing depression. For this reason, some people may get confused about what types of depression are associated with what terms. One of these terms is comorbidity, which can explain the connection between depression and other mental health conditions. Understanding comorbidity may help you understand your treatment plan, make informed treatment decisions, and treat your unique symptoms if you live with a mental illness like depression. 

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Comorbid depression can cause mental health complications

What is comorbidity? 

Some may connect the term “morbidity” with a gloomy demeanor or an affinity for dark subjects like death or violence. However, morbidity, by definition, refers to experiencing the symptoms of a disease or condition. In psychology, the term “comorbidity” refers to the presence of more than one disease, condition, or disorder simultaneously.  

The presence of comorbidity in any disorder, physical or mental, can increase the likelihood of a misdiagnosis. For example, anxiety symptoms can be confused with symptoms of a medical condition like adrenal dysfunction or cardiovascular disease, and depression symptoms can be confused with symptoms of anemia or hypothyroidism. 

Comorbidity also increases the complexity of diagnosis and treatment, especially when working with medications. For example, individuals diagnosed with depression may also live with bipolar disorder or other mood disorders requiring specific medications. Substance use disorders are commonly comorbid with depressive disorders and are often treated differently. 

Comorbidity between depression and anxiety

Any mental or physical illness can present as a comorbidity for depression. However, the most common conditions alongside depressive disorders are anxiety disorders, particularly generalized anxiety disorder (GAD) and panic disorder. The relationship is bi-directional; statistics suggest roughly 60% of people with depression present comorbid symptoms of anxiety disorders, and vice versa. 

The reasons for this relationship are thought to be behavioral and cognitive, but some studies point to a physiological connection as well. Anxiety and depression often feature the same chemical imbalances, so similar medications may be effective in treating both disorders. 

The symptoms of anxiety and depression are often connected. Depression can cause a lack of motivation and difficulty engaging in previously enjoyed activities. When a person experiencing depression has this symptom, they may shirk commitments and responsibilities. Due to the consequences of avoidance behaviors, an individual may then experience severe anxiety. Similarly, anxiety can make everyday tasks overwhelming and complicated, leading to increased depression or avoidance. 

Other common depression comorbidities 

Several mental and physical health conditions can be comorbid with depression, including but not limited to the following: 

  • Obsessive-compulsive disorder (OCD) 
  • Substance use disorder
  • Post-traumatic stress disorder (PTSD) 
  • Personality disorders
  • Dementia
  • Stroke
  • Cancer
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What are the symptoms of depression? 

Not to be confused with grief, bereavement, or sadness, depression doesn’t involve a process that an individual can “get over.” This condition often affects people at the core of their perceptions of self-worth. When left untreated, depression doesn’t go away on its own. When unaddressed, symptoms often evolve into more serious mental health challenges, increasing the likelihood of comorbidity. 

Depression is one of the most common psychological disorders, affecting an estimated one in six adults at some point in their lives. According to the Diagnostic Manual of Mental Health Disorders, symptoms of depression often vary from mild to severe and must last two weeks or more. Symptoms cause difficulties in daily life and impair a person’s ability to function normally. Below are several of the most common symptoms:  

  • Feelings of guilt or shame
  • Thoughts of hopelessness and worthlessness 
  • Intense sadness and a low mood
  • Physical pain, including gastrointestinal distress and headaches
  • Loss of interest and enjoyment in activities that once brought pleasure
  • Sleep disruptions
  • Appetite changes 
  • Difficulty concentrating
  • Loss of energy
  • Thoughts of death or suicide

Note that medical conditions like thyroid conditions or vitamin deficiencies can also mimic symptoms of depression, so speak to a doctor to rule out general medical causes. 

Risk factors for depression

While depression can occur at any age, it most commonly appears in the late teens to mid-20s. Women are twice as likely to develop depression than men, and the condition is inheritable. Beyond these factors, there are a few other causes of depression, including the following: 

  • Childhood trauma or post-traumatic stress disorder 
  • Stressful life events 
  • Low self-worth or pessimism 
  • Substance use 
  • Chronic health conditions 

Diagnosing depression with comorbidities

The diagnostic process for many mental and physical health conditions often begins with a physical exam and health evaluation. Your doctor may ask about your family history and order lab work to rule out any underlying physical cause. From there, your doctor may refer you to a mental health professional for an evaluation. 

When you meet with a therapist for the first time, they may ask about your symptoms, thoughts, behavior patterns, and feelings. You might also be asked to take a self-assessment questionnaire to supplement these questions during this meeting. Your therapist may also request to speak to your other healthcare providers using a release form with your consent. After the preliminary assessment, your mental health professional can compare the information they obtained about your case with the criteria for depression and any suspected comorbidities listed in the DSM-5.  

How is depression with comorbidities treated? 

Treatments for depression with comorbidity can depend on the specifics of your condition. You may undergo a psychotherapeutic treatment such as cognitive-behavioral therapy (CBT) or one of over 400 other modalities. Your therapist can work with you to determine how many sessions you partake in and how often. This treatment plan may change with time and circumstances.

In addition to therapy, your therapist may wish to consult your doctor or psychiatrist to talk about treatment notes. Note that therapists cannot prescribe medication or offer medication management as they are not medical doctors. For this reason, some people have a treatment team instead of working with one person. Medications for depression are often highly effective alongside therapy. However, consult your doctor before starting, changing, or stopping a medication.   

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Comorbid depression can cause mental health complications

Alternative support options 

Although it can be vital to treat depression as soon as possible, some people don’t seek help. The causes of avoiding support are varied and may include a lack of therapists in the area or difficulty commuting to and from appointments. Some people have a demanding schedule, making finding time to attend and commute to appointments challenging. Others may be unable to afford therapy or are self-conscious about talking to someone about their challenges. 

Finding a therapist through an online platform like BetterHelp can be an effective solution to overcoming these barriers. Online therapy is convenient, affordable, and often as effective as online therapy. For example, one meta-analysis cultivated findings from 64 trials measuring the effectiveness of online therapy vs. traditional therapy. Researchers reported that virtual therapy could be as effective as in-person therapy in treating anxiety and depression.

Online therapists are licensed, accredited, and experienced in treating anxiety and depression. You can schedule appointments when it’s convenient for you. In addition, if you require support from your therapist in-between appointments, you can message them throughout the week and receive responses when they’re available. 

Takeaway

If you’ve been experiencing symptoms of depression for two weeks or more, you’re not alone. It may benefit you to seek support from a licensed therapist to curb potential comorbidities and receive timely guidance.
Depression is treatable, and you're not alone
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